Treatments for Pectus excavatum in Children

When is the best time to do the surgery for pectus excavatum?

Twenty-five years ago, surgeons operated when the child was as young as 4. The cartilage content of the bones made repositioning easier and healing was faster. But too often, the condition would recur, especially during growth spurts, so now repairs are typically done during the teenage years.

How is a pectus excavatum treated?

For mild cases of pectus excavatum, there's really no reason for surgery. A shallow excavatum is unlikely to affect the operation of the heart or lungs at all, and your child's appearance will remain normal.

If the deformity is causing physical or social problems, it can be surgically repaired. There are two options, both of which require your child to be put under general anesthesia:

Ravitch

In this procedure, the surgeon makes an incision in your child's chest wall, removes the cartilage wedged between the ribs and breastbone and repositions the freed-up breastbone.

A bar is left in the chest wall to maintain the correct shape for six months, during which time your child has to refrain from activities that might involve a collision, like football.

The technique fixes the problem but leaves a scar visible on the chest.

Nuss

In this procedure, the incisions are made on the side of your child's chest wall. Then the surgeon inserts a bar laterally through the chest and moves the breastbone forward.

No cartilage is removed.

Scarring is less extensive.

The Nuss procedure doesn't remove any asymmetry in the way your child's chest looks.

The bar has to stay in for at least one year, and sometimes two.

What happens before surgery?

You'll schedule a preoperative evaluation one to two weeks before your child's surgery. At this time you will meet with the following surgical team members:

Nurse practitioner who works with the surgeon

Nurse

Anesthesiologist

During this meeting, you and your child will be able to ask any questions you might have about the surgery and the recovery process.

What should we expect after surgery?

Your child will go to the recovery room, and then be transferred to the surgical floor after approximately one to two hours.

Your child will remain in the hospital for four to six days after the surgery.

Your child may have a small rubber tube underneath the incision to allow any fluids to drain out. This will be removed one to two days after surgery.

Your child will be helped to walk the day after surgery.

Your child can eat/drink if feeling well the day after surgery.

It is not necessary to remove the stitches. They are under the skin and will dissolve on their own.

What are the benefits of repairing my child's excavatum?

In severe cases, repair of a pectus excavatum may help the function of the heart and lungs. But in most cases, the benefits are mostly psychological. For children who have been upset by their appearance, the surgery can make a big difference.

What is the long-term treatment plan?

Your child will need to see the surgeon two weeks after surgery to make sure that the area is healing well.

Your child should not return to gym or participate in contact sports until after this postoperative visit with the surgeon. The doctor or nurse practitioner will give you exact instructions, but usually we recommend refraining from contact sports for up to six months after the surgery.

Coping and support

There are a lot of resources available for your family—within Boston Children's, in the outside community and online. These include:

Patient education: From the very first visit, our staff will be on hand to walk you through your child's treatment and help answer any questions you may have. They'll also reach out to you by phone, continuing the care and support you received while here at the hospital.

Parent to parent: Would you like to talk with someone else whose child has been through one of these surgical procedures? We can put you in touch with other families who can share their stories.

Social work and mental health professionals: Our social workers and mental health clinicians have helped many other families in your situation. We can offer counseling and assistance with issues such as coping with your child's diagnosis and dealing with financial difficulties.

We are grateful to have been ranked #1 on U.S. News & World Report's list of the best children's hospitals in the nation for the third year in a row, an honor we could not have achieved without the patients and families who inspire us to do our very best for them. Thanks to you, Boston Children's is a place where we can write the greatest children's stories ever told.”